Josilainne Marcelino Dias

Comparing the Pilates method with no exercise or lumbar stabilization for pain and functionality in patients with chronic low back pain: Systematic review and meta-analysis

Objective: To perform a systematic review with meta-analyses that evaluates the effectiveness of the Pilates method on the pain and functionality outcome in adults with non-specific chronic low back pain. Data sources: The search was performed in the following databases: Medline, Embase, AMED, Cinahl, Lilacs, Scielo, SportDiscus, ProQuest, Web of Science, PEDro, Academic Search Premier and the Cochrane Central Register of Controlled Trials from 1950 to 2011; the following keywords were used: ‘Pilates’, ‘Pilates-based’, ‘back exercises’, ‘exercise therapy’, ‘low back pain’, ‘back pain’ and ‘backache.’ Review methods: The inclusion criteria were studies that assessed the effects of the Pilates method on patients with chronic low back pain. Results: Five studies met the inclusion criteria. The total number of patients was 71 in the Pilates group and 68 in the control group. Pilates exercise did not improve functionality (standardized mean difference (SMD = –1.34; 95% confidence interval (CI) −2.80, 0.11; P = 0.07) or pain between Pilates and control groups (SMD = –1.99; 95% CI −4.35, 0.37; P = 0.10). Pilates and lumbar stabilization exercises presented no significant difference in functionality (mean difference (MD) = –0.31; 95% CI −1.02, 0.40; P = 0.39) or pain (MD = –0.31; 95% CI −1.02, 0.40; P = 0.39). Conclusion: The Pilates method did not improve functionality and pain in patients who have low back pain when compared with control and lumbar stabilization exercise groups.

Facial exercise therapy for facial palsy: systematic review and meta-analysis

The effectiveness of facial exercises therapy for facial palsy has been debated in systematic reviews but its effects are still not totally explained. Objective: To perform a systematic review with meta-analysis to evaluate the effects of facial exercise therapy for facial palsy. Data sources: A search was performed in the following databases: Cochrane Controlled Trials Register Library, Cochrane Disease Group Trials Register, MEDLINE, EMBASE, LILACS, PEDro, Scielo and DARE from 1966 to 2010; the following keywords were used: ‘idiopathic facial palsy’, ‘facial paralysis’, ‘Bell’s palsy’, ‘physical therapy’, ‘exercise movement techniques’, ‘facial exercises’, ‘mime therapy’ ‘facial expression’, ‘massage’ and ‘randomized controlled trials’. Review methods: The inclusion criteria were studies with facial exercises, associated or not with mirror biofeedback, to treat facial palsy. Results: One hundred and thirty-two studies were found but only six met the inclusion criteria. All the studies were evaluated by two independent reviewers, following the recommendations of Cochrane Collaboration Handbook for assessment of risk of bias (kappa coefficient = 0.8). Only one study presented sufficient data to perform the meta-analysis, and significant improvements in functionality was found for the experimental group (standardized mean difference (SMD) = 13.90; 95% confidence interval (CI) 4.31, 23.49; P = 0.005). Conclusion: Facial exercise therapy is effective for facial palsy for the outcome functionality.

Translation, cross-cultural adaptation and analysis of the psychometric properties of the lower extremity functional scale (LEFS): LEFS- BRAZIL

BACKGROUND There is a lack of questionnaires in Brazilian Portuguese to evaluate patient-reported lower limb function. OBJECTIVE To translate, cross-culturally adapt to the Brazilian population, and evaluate the psychometric properties of the Lower Extremity Functional Scale (LEFS). METHOD The LEFS was translated by two independent assessors and back-translated to English. Then, the LEFS-Brazil was tested on 20 patients who answered the questionnaire in the cross-cultural adaptation phase. For the evaluation of the psychometric properties, 100 patients answered the questionnaire. The reliability was tested by two independent assessors. The Medical Outcomes Study 36-item from Health Survey (SF-36) was used as the criterion method for construct validity. The sensitivity to change was tested for four consecutive weeks. RESULTS The internal consistency was α = 0.96. The intra-observer reliability was CCI (intraclass correlation coefficient) = 0.96 and CCI interobserver = 0.98; the Bland and Altman mean difference (d) intra-observer = -1.52 and d interobserver = 0.46. The correlation between the LEFS and SF-36 in the first week was the following: physical function r=0.82, physical role r=0.57, emotional role r=0.43 and mental health r=0.33. The LEFS was responsive when comparing the mean of the first week to the second, third and fourth weeks and comparing the second to the fourth week. The cut-off point was 11, and the area under the receiving operator curve was 0.96 95% CI [0.88;0.99], with sensitivity = 0.96, 1-specificity = 0 and standard error = 0.02. CONCLUSION The LEFS-Brazil is reliable, valid and responsive.

The effectiveness of aquatic physical therapy in the treatment of fibromyalgia: a systematic review with meta-analysis

Objective: To assess the effectiveness of aquatic physical therapy in the treatment of fibromyalgia. Data sources: The search strategy was undertaken using the following databases, from 1950 to December 2012: MEDLINE, EMBASE, CINAHL, LILACS, SCIELO, WEB OF SCIENCE, SCOPUS, SPORTDiscus, Cochrane Library Controlled Trials Register, Cochrane Disease Group Trials Register, PEDro and DARE. Review methods: The studies were separated into groups: Group I – aquatic physical therapy × no treatment, Group II – aquatic physical therapy × land-based exercises and Group III – aquatic physical therapy × other treatments. Results: Seventy-two abstracts were found, 27 of which met the inclusion criteria. For the functional ability (Fibromyalgia Impact Questionnaire), three studies were considered with a treatment time of more than 20 weeks and a mean difference (MD) of −1.35 [−2.04; −0.67], P = 0.0001 was found in favour of the aquatic physical therapy group versus no treatment. The same results were identified for stiffness and the 6-minute walk test where two studies were pooled with an MD of −1.58 [−2.58; −0.58], P = 0.002 and 43.5 (metres) [3.8; 83.2], P = 0.03, respectively. Conclusion: Three meta-analyses showed statistically significant results in favour of the aquatic physical therapy (Fibromyalgia Impact Questionnaire, stiffness and the 6-minute walk test) during a period of longer than 20 weeks. Due to the low methodological rigor, the results were insufficient to demonstrate statistical and clinical differences in most of the outcomes.

The Effectiveness of Postoperative Physical Therapy Treatment in Patients Who Have Undergone Arthroscopic Partial Meniscectomy: Systematic Review With Meta-analysis

STUDY DESIGN Systematic review with meta-analysis. OBJECTIVES To evaluate the effectiveness of postoperative physical therapy treatment for patients who have undergone arthroscopic partial meniscectomy. BACKGROUND There is no consensus on which treatment is best for patients post meniscectomy. METHODS A search for articles published from 1950 to March 2013 was conducted in the MEDLINE, Embase, CINAHL, LILACS, SciELO, IBECS, Scopus, Web of Science, PEDro, Academic Search Premier, and Cochrane Central Register of Controlled Trials databases. The key words were physiotherapy, physical therapy modalities, exercise therapy, rehabilitation, knee, placebo, groups, tibial meniscus, meniscus, arthroscopy, meniscectomy, partial meniscectomy, randomized controlled trial, controlled clinical trial, randomized, systematic review, and meta-analysis. RESULTS Eighteen randomized controlled trials were included in the review, 6 of which were included in the meta-analysis. Outpatient physical therapy plus a home exercise program, compared to a home program alone, improved function compared to a home program alone (mean difference, 10.3; 95% confidence interval: 1.3, 19.3; P = .02) and knee flexion range of motion (mean difference, 9.1; 95% confidence interval: 3.7, 14.5; P = .0009). Inpatient physical therapy alone compared to inpatient plus outpatient physical therapy reduced the likelihood of effusion (odds ratio = 0.25; 95% confidence interval: 0.10, 0.61; P = .003). CONCLUSION Physical therapy associated with home exercises seems to be effective in improving patient-reported knee function and range of motion in patients post-arthroscopic meniscectomy, although the included randomized controlled trials were classified from moderate to high risk of bias and should be interpreted with caution. LEVEL OF EVIDENCE Therapy, level 1a-.

The Electromyographic Activity of the Multifidus Muscles During the Execution of Two Pilates Exercises—Swan Dive and Breast Stroke—for Healthy People

OBJECTIVE The purpose of this study was to compare the multifidus electromyographic activity in healthy women during the performance of the same Pilates exercise under 2 conditions. METHODS Sixteen healthy, active, female practitioners of Pilates (mean age, 24.3; SD, 3.1 years) were assessed through surface electromyography during 2 Pilates exercises (swan dive and breast stroke). Muscle activity during the experimental tasks was recorded with 1 pair of electrodes placed bilaterally on the multifidi. Data were normalized to maximal activity recorded during dynamic activity. RESULTS The mean of the maximal isometric voluntary contraction was 662.4 N (SD, 195). In the phase comparison, the multifidus was the most recruited on the concentric phase during both exercises, ball (P=.001) and reformer (P=.001). In the comparison between conditions, the reformer presented more activation on swan dive (P=.04) and breast stroke (P=.001). The percentages of muscle activation varied between 50% and 60%, and the greatest activation was made on the reformer condition. CONCLUSION The findings of this study show that Pilates exercises by healthy women, under different conditions, can cause changes to the multifidus muscle activation. The condition and the phase in which the muscle was more activated were the reformer and concentric phase, respectively, for both exercises. However, the results for the percentages of activation suggest that the intensity of recruitment may not be sufficient to strengthen muscle in healthy, trained subjects.

Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects

Low back pain (LBP) is one of the most common causes of disability, and the Pilates method has been associated with improvements in symptoms. The purpose of this study was to assess the effectiveness of the Pilates method, when compared to general exercises, on pain and functionality after eight weeks (16 sessions, 2×/week) and a follow-up of three months, in subjects with non-specific chronic low back pain (NSCLBP). A randomised controlled trial composed of 22 subjects was proposed. Subjects were allocated into two groups: the Pilates group (PG) (n = 11) and the general exercise group (GEG) (n = 11). The PG protocol was based on the Pilates method and the GEG performed exercises to manage NSCLBP. There were no differences between the groups. When analysed over time, the GEG demonstrated improvements in functionality between baseline and the end of treatment (P = .02; Cohensd¯ = 0.34) and baseline and follow-up (P = .04; Cohensd¯ = 0.31). There were no differences between the Pilates and general exercises with regard to pain and functionality in NSCLBP subjects but general exercises were better than Pilates for increasing functionality and flexibility.

Kinematic Gait Analysis Using Inertial Sensors with Subjects after Stroke in Two Different Arteries

[Purpose] The aim of the present study was described the kinematic characteristics of gait in stroke patients with two different arteries involved. [Subjects and Methods] Two patients who had suffered a basilar (A) or middle (B) cerebral artery ischemic stroke were compared with a control (C). Seventeen inertial sensors were used with acquisition rate of 120 Hz. The participants walked 3 times on a 10 meter walkway. From the raw data, the three gait cycles from the middle of each trial were chosen and analyzed. [Results] During the stance phase, patients A and B had a lower hip angle at initial contact and maximum flexion angle during load response than the control. Patient A and the control subject had similar knee angle values at initial contact, and patient B presented a flexed position in the initial phase of the gait cycle. The maximum flexion angles during loading response were also higher for patient B. The sagittal plane excursion for the ankle joint was lower for patient B in comparison with the other subjects. [Conclusion] Differences during walking between patients who had stroke in different arteries may be related to an alternative compensatory strategy. Patient A and the control subject had similar gait cycle curves at all joints, while patient B showed a rigid synergic pattern.

Time-of-Day Effect on Hip Flexibility Associated with the Modified Sit-and- Reach Test in Males

Flexibility is a key component of physical fitness. It has been suggested that measures of physical fitness components may vary throughout the day. The aim of this study was to analyse the effects of the time of day on flexibility performance. 26 men (mean age=25.4 years, SD=2.5) were evaluated by hip flexion on kinematic analysis and also by an absolute score in the modified Sit-and-Reach test during a repeated measure design. This was done during 3 experimental sessions, which took place at 8:00 a.m., 1:00 p.m. and 6:00 p.m., in random order. All subjects were previously familiarized with the test parameters. There was a diurnal variation only in the modified Sit-and-Reach test score between 8:00 a.m and 6:00 p.m. (P=0.01). There was no significant difference in the hip kinematic analysis between hours. These findings suggest that flexibility performance in the modified Sit-and-Reach test, in absolute scores, is affected by the time of day, with higher performance in the evening.

Postural Sway, Balance Confidence, and Fear of Falling in Women With Knee Osteoarthritis in Comparison to Matched Controls

Osteoarthritis (OA) is a chronic degenerative disease that commonly affects the knee joints. Individuals older than 65 years of age with knee OA have a greater risk of falls. However, there has been limited examination of the parameters of postural sway (increased time, speed, and postural sway area [center of pressure{CoP}]), and OA of the knee.